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Living with diabetes

When Tyler Bren first heard the diagnosis, he
had a number of thoughts swirl through his
9-year-old mind.

“What am I gonna do the rest of my life, and what
am I gonna be able to do in school or are people
gonna look at me different?” Tyler recalled thinking
back in 2004.

Those questions are understandable, especially for a
boy who just learned he has type 1 diabetes, a disease
for which there is no cure and one that requires
constant monitoring to keep in check.

Now 14, Tyler, who lives in Dickinson, no longer
carries any such fears, thanks largely to the coordinated
and innovative care he’s received from his team of
providers at Sanford Health.

Tyler Bren, right, and his family count on Sanford Health's team approach to care for the teenager's type 1 diabetes. Led by Pediatrician Dr. Parag Kumar, left, the team helps Tyler's family successfully manage the disease.

“We’ve got our ups and downs,”
said Duane Bren, Tyler’s father.
“For the most part, he does very well with it. He’s doing better with it than I would if I had it.” Such an outcome was far from
certain initially.

Tyler and his parents first realized
something was wrong when Tyler
lacked energy much of the time,
started drinking more water than
normal, lost 10 pounds in a short
amount of time and frequently
complained of simply not

“He was always wanting to
sleep,” said Marge Bren, Tyler’s mother. “He didn’t have
the energy or the boost to do just common-day things.
He wanted to lay around all day long.”

The symptoms grew progressively worse, and
ultimately, the Brens took Tyler to the emergency
department in Dickinson. After consulting with an
on-call pediatrician in Bismarck, the family was referred
to Sanford Health in Bismarck. Tyler was in critical
condition, and so he was rushed to Bismarck
via ambulance.

That’s when the Brens met Dr. Parag Kumar, a
pediatrician; Lyla Timm, a registered nurse in Sanford Diabetes Care Center; and Kelly
Fisher, a dietitian. From the moment Tyler entered the
hospital, that team started training Tyler and his family on everything they’d need to do to keep Tyler’s diabetes in check.

“We didn’t know anything about diabetes before we started,” Marge said.
“The team showed us everything we needed to know.”

By the time the Brens returned to Dickinson, they had a good enough
understanding of the disease to successfully manage Tyler’s diabetes.

When the Brens did run into a problem or had a question, someone from
Tyler’s care team was always available to answer any questions the family
had. That access became even more important when Tyler started using an
insulin pump three years ago, a move that meant Tyler no longer had to inject
himself with insulin four times a day but one that comes with a steep
learning curve.

“Starting the pump and taking care of diabetes is serious business,”
Dr. Kumar said, “so we have to be 100 percent accessible.”

Tyler was one of the first children in North Dakota to receive a pump, and
Dr. Kumar said he wouldn’t have even thought about the innovative move if it
wasn’t for the coordinated care and access Sanford Health can provide with
the staff in its Diabetes Care Center.

While wearing the pump makes some physical activities like playing sports
a little more challenging, Tyler participates in golf and baseball, and having
the device definitely beats multiple injections a day.

“It’s way easier,” Tyler said, “and it just helps me understand and get
through life.”

His blood sugar is better controlled now, and he said he can do anything
a normal teenager can.

“It is very gratifying as a physician to see him getting better,” Dr. Kumar said.
“The entire family has risen to the occasion.”

Dr. Kumar is quick to point out Tyler would not be nearly as successful
without the dedication of the Bren family.

“This requires such a commitment from the family and from Tyler,”
Dr. Kumar said, “and we’ve been very pleased with how they follow through
and are very trusting and follow our advice.”